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Breast Cancer Prevention in High Risk Patients - STAR Trial Findings
| Thank you to the more than 70 women who participated in the trial at Presbyterian Hospital; your willingness to help will lead us to a brighter future for cancer prevention. |
May 30, 2006
The STAR (Study of Tamoxifen and Raloxifene) trial, an initiative of the National Surgical Adjuvant Breast and Bowel Project (NSABP) that compared the use of Tamoxifen (Nolvadex) and Raloxifene (Evista) in the prevention of breast cancer in high-risk women, recently yielded some early data.
Raloxifene, although similar to Tamoxifen, has not yet been approved by the FDA as a drug to prevent breast cancer. Tamoxifen , had already been proven to reduce breast cancer by 50% compared to no medication in an earlier NSABP clinical trial. Raloxifene, however, has been effective in preventing osteoporosis in post-menopausal women. The supposition of the trial was that Raloxifene is just as effective as Tamoxifen in preventing breast cancer but also has the added benefit of preventing osteoporosis.
Tamoxifen has several undesirable side effects, namely, enhanced clotting problems and a slight increase in uterine cancer. If the supposition proved true then raloxifene might well be a better drug.
The early presentation of the data, representing almost 20,000 women, was recently presented. Strikingly enough, both raloxifene and tamoxifen were similar in preventing breast cancer, and there was no difference in bone fractures for either drug. Tamoxifen still had a slightly higher risk of uterine cancer - obviously not a problem in a woman with a hysterectomy, and more undesirable clotting problems. Interestingly, Raloxifene seemed to have a small yet more likely chance of not preventing non-invasive breast cancer (DCIS - ductal carcinoma in situ, and LCIS - lobular carcinoma in situ).
It is probably fair to say with a review of all the data that Raloxifene is a better option. However, Tamoxifen is still reasonable, especially in a woman who has had a hysterectomy and does not have a history of clotting problems. Also, Raloxifene costs about 2-3 times the cost of Tamoxifen.
There is much to be learned yet from this study. If you are a high risk patient and post-menopausal, you might want to discuss your options with your physician.
